s Good Manners Create Good Communications and Illustrate Respect and Care | I2P: Information to Pharmacists - Archive
Publication Date 01/07/2014         Volume. 6 No. 6   
Information to Pharmacists

Editorial

From the desk of the editor

Welcome to the July 2014 homepage edition of i2P (Information to Pharmacists) E-Magazine.
At the commencement of 2014 i2P focused on the need for the entire profession of pharmacy and its associated industry supports to undergo a renewal and regeneration.
We are now half-way through this year and it is quite apparent that pharmacy leaders do not yet have a cohesive and clear sense of direction.
Maybe the new initiative by Woolworths to deliver clinical service through young pharmacists and nurses may sharpen their focus.
If not, community pharmacy can look forward to losing a substantial and profitable market share of the clinical services market.
Who would you blame when that happens?
But I have to admit there is some effort, even though the results are but meagre.
In this edition of i2P we focus on the need for research about community pharmacy, the lack of activity from practicing pharmacists and when some research is delivered, a disconnect appears in its interpretation and implementation.

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News Flash

Newsflash Updates for July 2014

Newsflash Updates

Regular weekly updates that supplement the regular monthly homepage edition of i2P. 
Access and click on the title links that are illustrated

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Feature Contribution

Woolworths Pharmacy - Getting One Stage Closer

Neil Johnston

It started with “tablet” computers deployed on shelves inside the retailer Coles, specifically to provide information to consumers relating to pain management and the sale of strong analgesics.
This development was reported in i2P under the title Coles Pharmacy Expansion and the Arid PGA Landscape”
In that article we reported that qualified information was a missing link that had come out of Coles market research as the reason to why it had not succeeded in dominating the pain market.
Of course, Woolworths was working on the same problem at the same time and had come up with a better solution - real people with good information.

Comments: 5

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Intensive Exposition without crossing over with a supermarket

Fiona Sartoretto Verna AIAPP

Editor's Note: The understanding of a pharmacy's presentation through the research that goes into the design of fixtures and fittings that highlight displays, is a never-ending component of pharmacy marketing.
Over the past decade, Australian pharmacy shop presentations have fallen behind in standards of excellence.
It does not take rocket science - you just have to open your eyes.
Recently, our two major supermarkets, Woolworths and Coles, have entered into the field of drug and condition information provision - right into the heartland of Australian Pharmacy.

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The sure way to drive business away

Gerald Quigley

I attended the Pregnancy, Baby and Children’s Expo in Brisbane recently.
What an eye and ear opening event that was!
Young Mums, mature Mums, partners of all ages, grandparents and friends……...many asking about health issues and seeking reassurances that they were doing the right thing.

Comments: 1

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‘Marketing Based Medicine’ – how bad is it?

Baz Bardoe

It should be the scandal of the century.
It potentially affects the health of almost everyone.
Healthcare providers and consumers alike should be up in arms. But apart from coverage in a few credible news sources the problem of ‘Marketing Based Medicine,’ as psychiatrist Dr Peter Parry terms it, hasn’t as yet generated the kind of universal outrage one might expect.

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Community Pharmacy Research - Are You Involved?

Mark Coleman

Government funding is always scarce and restricted.
If you are ever going to be a recipient of government funds you will need to fortify any application with evidence.
From a government perspective, this minimises risk.
I must admit that while I see evidence of research projects being managed by the PGA, I rarely see community pharmacists individually and actively engaged in the type of research that would further their own aims and objectives (and survival).

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Organisational Amnesia and the Lack of a Curator Inhibits Cultural Progress

Neil Johnston

Most of us leave a tremendous impact on pharmacies we work for (as proprietors, managers, contractors or employees)—in ways we’re not even aware of.
But organisational memories are often all too short, and without a central way to record that impact and capture the knowledge and individual contributions, they become lost to time.
It is ironic that technology has provided us with phenomenal tools for communication and connection, but much of it has also sped up our work lives and made knowledge and memory at work much more ephemeral.

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Academics on the payroll: the advertising you don't see

Staff Writer

This article was first published in The Conversation and was written by Wendy Lipworth, University of Sydney and Ian Kerridge, University of Sydney
In the endless drive to get people’s attention, advertising is going ‘native’, creeping in to places formerly reserved for editorial content. In this Native Advertising series we find out what it looks like, if readers can tell the difference, and more importantly, whether they care.
i2P has republished the article as it supports our own independent and ongoing investigations on how drug companies are involved in marketing-based medicine rather than evidence-based medicine.

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I’ve been thinking about admitting wrong.

Mark Neuenschwander

Editor's Note: This is an early article by Mark Neuenschwander we have republished after the soul-searching surrounding a recent Australian dispensing error involving methotrexate.
Hmm. There’s more than one way you could take that, huh? Like Someday when I get around to it (I’m not sure) I may admit that I was wrong about something. Actually, I’ve been thinking about the concept of admitting wrong. So don’t get your hopes up. No juicy confessions this month except that I wish it were easier for me to admit when I have been wrong or made a mistake.
Brian Goldman, an ER physician from Toronto, is host of the award-winning White Coat, Black Art on CBC Radio and slated to deliver the keynote at The unSUMMIT for Bedside Barcoding in Anaheim this May. His TED lecture, entitled, “Doctors make mistakes. Can we talk about it?” had already been viewed by 386,072 others before I watched it last week.

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Dispensing errors – a ripple effect of damage

Kay Dunkley - BPharm, Grad Dip Hosp Pharm, Grad Dip Health Admin, MPS, MSHPA

Most readers will be aware of recent publicity relating to dispensing errors and in particular to deaths caused by methotrexate being incorrectly packed in dose administration aids.
The Pharmacy Board of Australia (PBA), in its Communique of 13 June 2014, described a methotrexate packing error leading to the death of a patient and noted “extra vigilance is required to be exercised by pharmacists with these drugs”.
This same case was reported by A Current Affair (ACA) in its program on Friday 20 June
http://aca.ninemsn.com.au/article/8863098/prescription-drug-warning

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Take a vacation from your vocation

Harvey Mackay

Have you ever had one of those days when all you could think was, “Gosh, do I need a vacation.”
Of course you have – because all work and no play aren’t good for anyone.
A vacation doesn’t have to be two weeks on a tropical island, or even a long weekend at the beach. 
A vacation just means taking a break from your everyday activities. 
A change of pace. 
It doesn’t matter where.
Everyone needs a vacation to rejuvenate mentally and physically. 
But did you also know that you can help boost our economy by taking some days off? 
Call it your personal stimulus package.

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Explainer: what is peer review?

Staff Writer

This article was first published in the Conversation. It caught our eye because "peer review" it is one of the standards for evidence-based medicines that has also been corrupted by global pharma.
The article is republished by i2P as part of its ongoing investigation into scientific fraud and was writtenby Andre Spicer, City University London and Thomas Roulet, University of Oxford
We’ve all heard the phrase “peer review” as giving credence to research and scholarly papers, but what does it actually mean?
How does it work?
Peer review is one of the gold standards of science. It’s a process where scientists (“peers”) evaluate the quality of other scientists' work. By doing this, they aim to ensure the work is rigorous, coherent, uses past research and adds to what we already knew.
Most scientific journals, conferences and grant applications have some sort of peer review system. In most cases it is “double blind” peer review. This means evaluators do not know the author(s), and the author(s) do not know the identity of the evaluators.
The intention behind this system is to ensure evaluation is not biased.
The more prestigious the journal, conference, or grant, the more demanding will be the review process, and the more likely the rejection. This prestige is why these papers tend to be more read and more cited.

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Dentists from the dark side?

Loretta Marron OAM BSc

While dining out with an elderly friend, I noticed that he kept his false tooth plate in his shirt pocket. He had recently had seven amalgam-filled teeth removed, because he believed that their toxins were making him sick; but his new plate was uncomfortable. He had been treated by an 'holistic dentist'. Claiming to offer a "safe and healthier alternative" to conventional dentistry, are they committed to our overall health and wellbeing or are they promoting unjustified fear, unnecessarily extracting teeth and wasting our money?

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Planning for Profit in 2015 – Your key to Business Success

Chris Foster

We are now entering a new financial year and it’s a great time to reflect on last year and highlight those things that went well and those that may have impacted negatively in the pursuit of your goals.
It's also a great to spend some time re-evaluating your personal and business short, medium and long term goals in the light of events over the last year.
The achievement of your goals will in many cases be dependent on setting and aspiring to specific financial targets. It's important that recognise that many of your personal goals will require you to generate sufficient business profits to fund those aspirations

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ReWalk™ Personal Exoskeleton System Cleared by FDA for Home Use

Staff Writer

Exoskeleton leader ReWalk Robotics announced today that the U.S. Food and Drug Administration has cleared the company’s ReWalk Personal System for use at home and in the community.
ReWalk is a wearable robotic exoskeleton that provides powered hip and knee motion to enable individuals with Spinal Cord Injury (SCI) to stand upright and walk.
ReWalk, the only exoskeleton with FDA clearance via clinical studies and extensive performance testing for personal use, is now available throughout the United States.

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Attracting and Retaining Great People

Barry Urquhart

Welcome to the new financial year in Australia.
For many in business the past year has been described as a challenging period.
Adjectives are a key feature of the English language.  In the business lexicon their use can be, and often is evocative and stimulate creative images.  But they can also contribute to inexact, emotional perceptions.
Throughout the financial pages of newspapers and business magazines adjectives abound.
References to “hot” money draw attention and comment.  The recent wave of funds from Chinese investors, keen to remove their wealth from the jurisdiction and control of government regulations is creating a potential property bubble in Australia.

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Updating Your Values - Extending Your Culture

Neil Johnston

Pharmacy culture is dormant.
Being comprised of values, unless each value is continually addressed, updated or deleted, entire organisations can stagnate (or entire professions such as the pharmacy profession).
Good values offer a strong sense of security, knowing that if you operate within the boundaries of your values, you will succeed in your endeavours.

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Evidence-based medicine is broken. Why we need data and technology to fix it

Staff Writer

The following article is reprinted from The Conversation and forms up part of our library collection on evidence-based medicines.
At i2P we also believe that the current model of evidence is so fractured it will never be able to be repaired.
All that can happen is that health professionals should independently test and verify through their own investigations what evidence exists to prescribe a medicine of any potency.
Health professionals that have patients (such as pharmacists) are ideally placed to observe and record the efficacy for medicines.
All else should confine their criticisms to their evidence of the actual evidence published.
If there are holes in it then share that evidence with the rest of the world.
Otherwise, do not be in such a hurry to criticise professions that have good experience and judgement to make a good choice on behalf of their patients, simply because good evidence has not caught up with reality.

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Laropiprant is the Bad One; Niacin is/was/will always be the Good One

Staff Writer

Orthomolecular Medicine News Service, July 25, 2014
Laropiprant is the Bad One; Niacin is/was/will always be the Good One
by W. Todd Penberthy, PhD

(OMNS July 25, 2014) Niacin has been used for over 60 years in tens of thousands of patients with tremendously favorable therapeutic benefit (Carlson 2005).
In the first-person NY Times best seller, "8 Weeks to a Cure for Cholesterol," the author describes his journey from being a walking heart attack time bomb to a becoming a healthy individual.
He hails high-dose niacin as the one treatment that did more to correct his poor lipid profile than any other (Kowalski 2001).

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Culture Drive & Pharmacy Renewal

Neil Johnston

Deep within all of us we have a core set of values and beliefs that create the standards of behaviour that we align with when we set a particular direction in life.
Directions may change many times over a lifetime, but with life experiences and maturity values may increase in number or gain greater depth.
All of this is embraced under one word – “culture”.
When a business is born it will only develop if it has a sound culture, and the values that comprise that culture are initially inherent in the business founder.
A sound business culture equates to a successful business and that success is often expressed in the term “goodwill” which can be eventually translated to a dollar value.

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ReWalk™ Personal Exoskeleton System Cleared by FDA for Home Use

Staff Writer

Exoskeleton leader ReWalk Robotics announced today that the U.S. Food and Drug Administration has cleared the company’s ReWalk Personal System for use at home and in the community.
ReWalk is a wearable robotic exoskeleton that provides powered hip and knee motion to enable individuals with Spinal Cord Injury (SCI) to stand upright and walk.
ReWalk, the only exoskeleton with FDA clearance via clinical studies and extensive performance testing for personal use, is now available throughout the United States.

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Pharmacy 2014 - Pharmacy Management Conference

Neil Johnston

The brave new world of health and wellness is not the enemy of Pharmacy, it is its champion.
Australian futurist, Morris Miselowski, one of the world's leading business visionaries, will present the Opening Keynote address on Pharmacy's Future in the new Health and Wellness Landscape at 2.00pm on Wednesday July 30.
Morris believes the key to better health care could already be in your pocket, with doctors soon set to prescribe iPhone apps, instead of pills.
Technology will revolutionise the health industry - a paradigm shift from healthcare to personal wellness.
Health and wellness applications on smartphones are already big news, and are dramatically changing the way we manage our personal health and everyday wellness.

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Generation and Application of Community Pharmacy Research

Neil Johnston

Editor’s Note: We have had a number of articles in this issue relating to pharmacy research.
The PGA has conducted a number of research initiatives over the years, including one recently reported in Pharmacy News that resulted from an analysis of the QCPP Patient Questionnaire.
Pharmacy Guild president, George Tambassis, appears to have authored the article following, and there also appears to be a disconnect between the survey report and its target audience illustrated by one of the respondent comments published.
I have asked Mark Coleman to follow through, elaborate and comment:

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Good Manners Create Good Communications and Illustrate Respect and Care

Peter Sayers

articles by this author...

Peter Sayers is vitally concerned about pharmacy professional practice - its innovation, its research and development, and its delivery to create an ongoing revenue stream. Delivery of healthcare is increasingly involved with Information Technology systems. All perspectives in IT must be considered for the impact on pharmacy practice and its viability.

Pharmacy has always “won its stripes” utilising its ability to be able to relate to individuals in an empathetic manner.
Patients have always reacted positively in accepting what pharmacists have offered to them as a health benefit.
Trouble is, the health benefits have not expanded progressively and pharmacists have become less visible under the mountain of PBS paperwork, bureaucracy and sundry critics that drown out pharmacist voices.
Now the price is about to be paid as government payments to pharmacists will reduce according to their view of the value of a pharmacist, which will be seen as almost non-existent.
And pharmacists, being survivors, will have to limit their time-investment in the PBS because it will not represent good value to them or their patients.

Already, we are being advised that pharmacists should relocate their professional home from a dispensary to a clinical space.
But that space has not been properly prepared and when history provides a considered perspective, it will be found that the militant disengagement by official pharmacy (until recently) was the culprit.
Nearly 30 years of wasted opportunity has passed us by and we have been very unprepared because of our reliance on a single nationally orchestrated and managed health care policy.
Even in the best of times it never works and falls apart because of the non-recognition of the valued inputs available from individual practitioners.
And it must also be noted that GP’s have continually stirred the pot when they perceived that pharmacists seemed to claim “turf” that they should not have been anywhere near (in their opinion).
To such an extent that even when “collaboration” is practiced with good intent, there are massive gaps in perception and communication that will have to be systematically addressed.
Other solutions will have to be found, ideally through a system of trusted mentors where a “dial-a-friend” solution can be made available that will fit in with a busy day at the office.
That type of system is where the application of government funding could become extremely effective.

Marketing guru, Seth Godin, sums it up in a slightly different way:

“A parade of tourists is going to walk past your store today.
Each is a separate opportunity for you to tell a story, to engage, to make a sale.

A connected community of readers is going to read what you wrote today.
A cultural shift will occur among a small group of people because they will share, discuss and engage with each other about what you wrote.

Here's the key question: are you trying to change an individual or are you trying to incite/inspire/redirect the tribe?”

In pharmacy terms he is saying how are we going to deal with our patients – individually or collectively?

Most primary care contacts will be with individual patients and they will be addressed with protocols that are suited to the pharmacist/patient context.
However, occasional opportunities occur to deal with a patient group collectively in the form of a seminar (conducted in the pharmacy or in a larger alternative venue).

The following is an example of a patient contact in a general practice setting  illustrated by Dr Jon Fogarty in a recent article he penned in Australian Doctor titled  “5 (not so easy) steps to a consultation” 

For those who are contemplating the delivery of clinical services within a busy pharmacy environment, it makes a compelling statement, and its essence is courtesy and good manners.

“First is the ‘hello’. Not as simple, nor self-evident, nor trivial as it sounds. The ‘hello’ sets the tone for the visit. The doctor who stands indifferently at the entrance of a waiting room, looking with tedium at the front page of a file before announcing to no one in particular, “Peter Jones”, then turning on her heel and retreating to an inner sanctum is unlikely to engender much love and joy from P Jones Esq.

If Mr Jones is visiting because of an earache, it may not matter much. If he has recently noted some pearly penile papules, he may decide that this is a matter best left for another day, and the visit is wasted.

The other bit about the “hello” is that it helps to be sure that you are talking to who you think you are talking to. If you start by saying: “Well, it’s not good news I’m afraid, Mrs Browne.”

“No?”

“No, sadly not. It is my grim duty to inform you that you have Hairy Kwarsheewonkey’s Disease, I’m afraid.”

‘What?!!!”

“Yes, a definite case of full-blown Hairy Kwarsheewonkey’s Disease, or HKD as we doctors like to call it, if ever I saw one.”

“Are you sure???!!!”

“Yes, yes. And a slight touch of cancer if I’m not mistaken, going on these figures.”

“OMG … surely there is some mistake. I only came about my cholesterol.”

“Ummm, are you Browne with an e?”

“No, no … no e.”

“Ah well, there you go. Let’s see now. Cholesterol is perfect. Wonderful. Who’s a lucky lady then?”

You might get away with it, but you might not. It doesn’t look good.

It also helps to have a quick look at previous notes prior to starting the visit. A start like: “Hello, my name is Jon Fogarty. How can I help you today?” may sound pretty good, but if the answer is, “You asked me yesterday to come back to talk more about the depression and suicide thoughts you’ve been treating me for,” well, again, it doesn’t engender the best ambience, if you get my drift. 

Worse, of course, if your name is not Jon Fogarty.
Worse still if you have intermittently treated the patient and his family for the past 10 years. This advice may be less relevant to younger readers, and they are welcome to roll their eyes and look superior if they must.

Step two is the ‘What are we doing today?’ section. This requires the doctor to get their hand on ‘the list’ early.

Experienced players will know the pain of spending 20 minutes (or 21 minutes for very experienced players) dealing with problems A and B to then discover that the real issue, the pearly penile papules, is revealed at the 22-minute mark.

Steps three and four are diagnosis and management, involving a lifetime of learning and surprises.

Step five is follow-up. In my view, a brief, handwritten summary and plan for review if necessary saves the confusion that can occur between departing the room and reaching the car park. So, there it is. Then do it all again. And again. And again.

The essence of Jon Fogarty’s words illustrate his experience in his dealings with patients and it is also an example of the word “care” a term that is bandied around in both medical and pharmacy settings – but sometimes the concept of care is missing, empty or meaningless.
Result?
A very disappointed patient.

On a slightly different note, I was watching a recent ABC interview of Alexander McCall Smith, a Rhodesian-born British writer and Emeritus Professor of Medical Law at the University of Edinburgh. In the late twentieth century, McCall Smith became a respected expert on medical law and bioethics and served on British and international committees concerned with these issues. He has since become internationally known as a writer of fiction. He is most widely known as the creator of the The No. 1 Ladies' Detective Agency series.

The interviewer commented on his very polite demeanor and how this had translated into the various characters within his novels. He responded by stating that good manners were essential in the normal discourse of life because good manners illustrated that you had respect for the person you were communicating with, which in turn illustrated that you cared about that person.
Good manners quickly break down barriers.
As I listened to this interview I became aware of how far my own personal standard for manners had slipped over the years and determined that from that point on I would greet all patients each day, with the friendliest and most heartfelt “hello” I can muster.
Jon Fogarty is right when he states “First is the ‘hello’. Not as simple, nor self-evident, nor trivial as it sounds. The ‘hello’ sets the tone for the visit.

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